Abstract

Friday, December 8, 2017

A heterogeneous condition

One of
the distinctive aspects of Alzheimer’s is that no two people exhibit the
precise same symptoms. That was one of the key points in a speech by Dr. Brad
Dickerson, a behavioral neurologist at Massachusetts General Hospital. I understand
Dickerson’s comment pertaining to the complexity of the human brain and the
nervous system, compared, to, say, heart disease, which in recent decades has
become a far more manageable condition.

Dickerson, this year’s Simons Symposium speaker in Newton,
Massachusetts, touted the promise of “precision medicine” as a possible
fruitful means of curbing Alzheimer’s. A key element in this quest are biomarkers,
which are defined by one source as a “broad subcategory of medical signs—that
is, objective indications of the medical state observed from outside the
patient—which can be measured accurately and reproducibly.”

In a practical sense, Dickerson noted that biomarkers can
help doctors determine whether patients will stay in the mild cognitive decline
or advance into full-blown Alzheimer’s disease. “We actually do a pretty good
job with the tools that we have now,” Dickerson noted. And there are now
specialized amyloid PET scans involving biomarkers. In some cases, people have
a 90 percent chance ofdeveloping
Alzheimer’s. But if individuals knew well ahead of time that they were at risk
of Alzheimer’s, they could change their lifestyles in terms of exercise, diet,
sleep habits and other factors.

One question asked of Dickerson concerned the very broad
life range, post-diagnosis. “And as anyone who has spent time in a support
group for people with Alzheimer’s, or in a group for their care partners, the
progress of the disease can vary widely. “The bottom line is that Alzheimer’s
is a heterogeneous condition,” Dickerson stated. “The speed can be very
different among individuals.”The
amount of shrinkage in the brain varies widely as well.

Dickerson also noted, pointedly, that no new
Alzheimer’s drug has been approved for roughly fifteen years, despite the
substantial money that has been raised, from both private and public sources.
And, as we learned about a year ago,
there was hope that an Eli Lilly drug candidate might slow the pace of the
disease. That, in itself, would have been a very encouraging step. But that,
too, went by the boards.Still, for
those of us in a relatively early stage of the disease, there is still hope for
a breakthrough.